Guest Columns

Strategies to create outcome assessments

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James Lomastro
James Lomastro
In my first post, I explored the need for good outcome assessment under the Affordable Care Act. Today I propose the elements to strong outcome assessment and performance improvement. 

Elements of Outcome Assessment/Performance Improvement

There are four elements of outcome assessment and performance improvement. They are: 

  • Strategy
  • Input from constituents
  • Measurement management and change management 
  • Performance improvement. 

Leadership, governance, talent (people) services and safety programs supports these effort. The purpose of the outcome assessment system is to increase value to constituents served through feedback and improvement.


Strategy is the assessment of value that the organizations bring to its constituents. Each facility develops their strategy. In the coming reform environment, each organization will determine their strategy based on their location, current and future capacities and especially the needs of the ACO and other constituents.

As part of strategy, the organization assesses stakeholder expectations and environmental impact. Become aware of the demographics that drive care. Customers search out the environment based on possible situations or areas where they will need help. Competitive analysis occurs not only with like facilities, but in case of skilled facilities with other levels of care. Stakeholders access opportunities (what the facility moves toward) and threats (what they move away from). The emphasis is on anticipation and proactive actions and to reacting. If the strategy is to develop “early warning systems” to assess threats and problems, the process becomes reactive.

Organizations match this strategic data with organizational capacities, which is present, and assess the need for future carrying capacity of the organization. This process sets down goals and objectives with priorities and updates as needed. In this process there are three major stakeholders — residents and families, staff and external others such as ACO leaders. The strategy or strategies are shared with persons served, staff and external stakeholders. The purpose is to secure understanding and commitment to the process. 

Input: Collection of Data

Input is not necessarily evidence.  We are not speaking solely to improving clinical performance, which is a part of the process. The input is related to the organization and program performance and not solely clinical. It is continuous. It employs a variety of mechanisms, mostly those that are readily available and collected as part of the on-going process. Input is gathered from the persons served by the organization, staff and other stakeholders.

Data input will be in many forms — quality indicators, clinical indicators, complaints, satisfaction surveys, interviews, audits, event reports, complaints, routine assessments and the like. Input is in as real time as possible. Most of the data you need is already collected by the organization for other purposes. Most organizations have a great deal of data available to them. The issue is not the data and input — it's whether the data is analyzed and used in program planning, advocacy and resource allocation

When we discuss data, remember it does not have to be extensive. It's more important that it has relevance and is reliable, measuring what it is intended to measure. Over time the organization will determine through the process what the value of various inputs.

Measurement Management: Data To Information

While a strategy is critical and input is important it will not produce results unless we have a measurement system capable of managing the data. It is critical to manage the data collected such as quality indicators, risk measures, financial information, survey reports, resource utilization and other indicators of performance.

The management of the input and data assures that the data addresses all three key constituencies; it is comparative; it uses measures that efficient and effective: data is collected at multiple points, accessible; and in a form that produces results. Without a management system the input remains data and does not become information. When data is processed, organized, structured or presented in a given context so as to make it useful. That's information. Information is understanding or knowledge that the organization exchanges with others. It is at this juncture that the organizations makes a judgment and interprets the data based on their mental models. It is at this juncture that the organization determines the usefulness of what the data indicates.

No matter how you get your information, the process needs to involve as many of the members of the organization as possible. Including them in the measurement management system also provides ways of checking and “scrubbing the data and results.

But how do we create change through information?

Through the measurement management we formulate information that we will use to improve the program, services and organization. The purpose of doing it is to improve and become better. It does little good if the organization does not use the information, which it creates to make itself better. The information provides feedback to the system and necessarily to individual components of the process. How the organization uses the information will depend on its experience, appetite for change and capacity for change.  


ACA will necessitate many changes not only in the way that we deliver services but also the way that we think about healthcare. Each organization will develop its approach to outcome assessment based on its structure and environment. Outcome management will necessitate significant changes in how we organize, manage and use data and create information. Much of reform will occur in the implementation of ACA. By managing change, enhancing performance and becoming more proficient, we contribute to the change that is occurring. It is in this implementation that many organizations will have a role in changing the way that we provide healthcare.

James Lomastro, Ph.D., has worked in acute, community based and long-term care for 33 years. He has held an administrator license since 1991. Prior to involvement in administration, he held academic and research appointments at Boston University School of Medicine and Northeastern University.

Guest Columns

Guest columns are written by long-term care industry experts, ranging from academics and thought leaders to administrators and CEOs.